What is Melasma and How Do You Treat It?
Dr. Angel Rivera
Melasma, sometimes referred to as chloasma, is a skin disorder characterized by darker spots on the skin. The patches can vary in color from light brown to dark brown, and some spots may have more of a blue-gray tone.
Symptoms of Melasma
The skin patches or hyperpigmented regions can show up in a single area or as multiple spots most typically on the face. There are three clinical patterns of melasma:
- The centrofacial pattern is the most common pattern and covers the largest part of the face. People with the centrofacial pattern have spots on the chin, upper lip, forehead, cheeks, and nose.
- The molar pattern is characterized by spots throughout the cheeks and nose.
- The mandibular pattern is expressed on the jawline, also known as the ramus of the mandible.
While melasma spots are mostly expressed on the face, some people also find spots on their neck or forearms. Melasma spots do not cause pain and are not associated with any other symptoms outside of the hyperpigmented spots. People with melasma may suffer from anxiety and depression.
How is Melasma Diagnosed?
The diagnosis for melasma is very straightforward. A dermatologist can diagnose melasma by looking at the skin. A dermatologist may take a skin biopsy to ensure that the patches are not caused by a different skin condition. A dermatologist may also use a Wood’s lamp, which is a type of black light, to determine how deeply the melasma penetrates the skin.
Who is at Risk of Getting Melasma?
A comprehensive review article of melasma finds that the prevalence varies dramatically depending on the study and population. The article goes on to cite several studies that show the prevalence can range from as low as 1% of the population to as high as 50% in populations of high-risk. People with darker skin tend to have a higher risk of melasma. Some ethnic backgrounds such as Latin or Hispanic, Indian, Middle Eastern, Mediterranean, and African American or North African descents are at a higher risk of developing melasma.
Females are also at a higher risk of developing the skin condition. It is generally accepted that men account for only 10% of the melasma cases. However, some studies have found the female to male ratio can also vary significantly depending on the study. For example, a Brazilian study found a 39:1 female to male incidence ratio in 953 melasma patients. In a study of 312 melasma patients in India, the female to male ratio was 4:1. These studies suggest that there may be many factors that impact the risk of melasma.
What Causes Melasma?
While the exact cause of melasma is unknown, there are several factors that trigger melasma and make it worse. Typically, the spots will fade after the trigger is removed.
Ultraviolet (UV) light from the sun can trigger and exacerbate melasma. Specifically, UV light promotes melanogenesis, or the production of melanin pigments, possibly by inducing the production of reactive oxygen species. Visible light can also cause an increase in the pigmentation that can last up to 3 months.
According to the American Academy of Dermatology Association, a change in hormones either caused by pregnancy, birth control pills, or hormonal replacement therapy can trigger the skin disorder. Melasma is often referred to as the “mask of pregnancy” because of the increased incidence in women during the second or third trimester of pregnancy.
While there have not been any genome-wide studies to implicate specific genes with melasma, family history has been shown to be a risk factor. A case-controlled study of 207 melasma patients in Brazil found a family history of melasma in 61% of cases.
How is Melasma Treated?
Melasma may fade on its own once the trigger has been removed. For example, if the melasma was caused by hormonal changes, the spots may fade after pregnancy or by getting off birth control pills. If the melasma was caused by sunlight, protection from the sun by using a sunscreen that is higher than SPF 30 or avoiding direct sunlight can help the spots fade. Some people may notice that specific skin care products such as lotions or soaps can aggravate the condition and may see the spots fade once they stop using those products. Some people may require medication or other procedures to accelerate the fading of the spots.
There are topical medications that can help reduce the appearance of melasma spots. The majority of topical medications require a prescription from a dermatologist. Some topical medications prevent the formation of melanin by inhibiting the tyrosinase enzyme. Hydroquinone is considered the first-line therapy for treating melasma. Hydroquinone is a tyrosinase inhibitor that acts as a skin-lightening agent that can be used to accelerate the fading. Topical hydrocortisone can also be used to fade the appearance of the spots.
Some people may choose to see a skincare specialist to help reduce the appearance of melasma by removing the top layer of the skin. A chemical peel, which is typically done by a dermatologist, involves using a chemical agent to burn the skin.
Microdermabrasion is a gentle procedure that involves using crystals, typically sand, to resurface the skin. Microdermabrasion has been shown to help reduce the appearance of melasma.
Laser treatments or light-based procedures have also been shown to be effective treatments for patients that do not see improvement after using topical creams, chemical peels, or microdermabrasion.
It is important to consult a healthcare professional before beginning any treatment, especially if the melasma is caused by pregnancy to ensure the medication can be used in pregnant women. Some people may need to use a combination of therapies for the spots to fade completely. Some treatment options work well for some patients but can aggravate the condition in others. Always speak to a healthcare profession to discuss which treatment options are best for your needs.
While there is no cure for melasma, the spots may fade on their own or after treatment. Some people may need to do maintenance treatment to prevent the melasma from coming back. Since UV light will exacerbate melasma, it is important to minimize sun exposure and wear sunscreen to avoid aggravating the condition or triggering a recurrence after the spots have faded.
References and Sources
- Melasma - Cleveland Clinic
- Ogbechie-Godec OA, Elbuluk N. Melasma: an Up-to-Date Comprehensive Review. Dermatol Ther (Heidelb). 2017;7(3):305-318. doi:10.1007/s13555-017-0194-1
- Hexsel D, Lacerda DA, Cavalcante AS, et al. Epidemiology of melasma in Brazilian patients: a multicenter study. Int J Dermatol. 2014;53(4):440-444. doi:10.1111/j.1365-4632.2012.05748.x
- Achar A, Rathi SK. Melasma: a clinico-epidemiological study of 312 cases. Indian J Dermatol. 2011;56(4):380-382. doi:10.4103/0019-5154.84722
- Rajanala S, Maymone MBC, Vashi NA. Melasma pathogenesis: a review of the latest research, pathological findings, and investigational therapies. Dermatol Online J. 2019;25(10):13030/qt47b7r28c. Published 2019 Oct 15.
- Handel AC, Lima PB, Tonolli VM, Miot LD, Miot HA. Risk factors for facial melasma in women: a case-control study. Br J Dermatol. 2014;171(3):588-594. doi:10.1111/bjd.13059
- Dabas G, Vinay K, Parsad D, Kumar A, Kumaran MS. Psychological disturbances in patients with pigmentary disorders: a cross-sectional study. J Eur Acad Dermatol Venereol. 2020;34(2):392-399. doi:10.1111/jdv.15987
- Melasma: Diagnosis and Treatment - American Academy of Dermatology Association
- Sun Damage: Melasma - Mayo Clinic
- Sarkar R, Bansal S, Garg VK. Chemical peels for melasma in dark-skinned patients. J Cutan Aesthet Surg. 2012;5(4):247-253. doi:10.4103/0974-2077.104912
- El-Domyati M, Hosam W, Abdel-Azim E, Abdel-Wahab H, Mohamed E. Microdermabrasion: a clinical, histometric, and histopathologic study. J Cosmet Dermatol. 2016;15(4):503-513. doi:10.1111/jocd.12252
- Trivedi MK, Yang FC, Cho BK. A review of laser and light therapy in melasma. Int J Womens Dermatol. 2017;3(1):11-20. Published 2017 Mar 21. doi:10.1016/j.ijwd.2017.01.004